The Dis-Ordered Self: Reenvisioning a Foucauldian Prescription for Ethics and Spirituality in Personality Pathology

Contemporary psychiatry continues to experience structural and procedural problems of self-definition. Nosology and classification systems of psychiatric illnesses betray ontological assumptions that are, oftentimes, contradictory and confused—positions such as essentialist/realist, antiessentialist/pragmatic, and eliminative materialist. Without a robust ontology undergirding its claims about abnormal contra normal human states and experiences, the appropriate borders of psychiatry remain unclear. This becomes particularly problematic in the diagnosis of personality disorders, where pathology is viewed as constitutive to the subject (patient). Despite changes in DSM-5 eliminating the axial system which had cleaved personality disorders from other syndromes, and despite the inclusion of an “alternative” hybrid categorical-dimensional model for diagnosis of personality disorders, we maintain that DSM-5’s personality disorder classification system continues the practice of making claims about subjectivity, broadly construed, without any prior grounding in a positive ontology of the self. Drawing from Foucault's Hermeneutics of the Subject, where he explores the modern schism between Socrates’ dual injunction to care for the self and know oneself with the former underwriting the latter, we argue that personality pathology classification systems set up a fractured relationship between the subject and truth with moral consequences; namely, that psychiatry offers a damning way of knowing the self excised from the requisite means to care for the self. Instead, psychiatric systems reproduce the split that originates with Descartes, where self-knowledge qua personality aberration is more concerned with the facticity of a diagnosis in order to approximate truth in the form of scientific and technical knowledge. This has important consequences for the subject: the subject is relegated to the confines of immanence; the subject is paradoxically both static and unstable; the subject’s relationality is categorically stunted and socially incompatible. Ultimately, without the ethical articulation of how both care of the self and knowing oneself relates to the subject, to others, and to the world, such a constitution of the subject precludes healing, the very task from which psychiatry draws its claims to authority. Therefore, we call for a reunion between self-knowledge, care of the self, and spiritual practices, or else, that psychiatry proceed cautiously in diagnosing personality disorders.